[28] Contraception - Male And Female Sterilisation Flashcards

1
Q

What is sterilisation?

A

A surgical means of obtaining permanent contraception

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2
Q

How does sterilisation work?

A

By occluding the Fallopian tubes in women, and vas deferens in women

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3
Q

What documentation should be done before performing sterilisation?

A
  • Consent form should be signed

- Clear documentation about discussion, information given, and any requests made by the individual

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4
Q

What specific issues need to be covered when obtaining consent for sterilisation?

A
  • Failure rate
  • Irreversibility
  • Time constraints
  • Choice of procedure
  • Alternative options
  • Limitations
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5
Q

Is sterilisation irreversible?

A

Yes (well no, but should be seen as an irreversible procedure)

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6
Q

What should the patient be told regarding reversal options for sterilisation?

A
  • Success rate as defined by successful pregnancy is very limited
  • Operation is not available on the NHS
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7
Q

When is female sterilisation effective from?

A

Woman is sterile immediately after operation, but can conceive in pre-operative menstrual cycle

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8
Q

What should the woman be advised regarding being able to conceive in the pre-operative menstrual cycle?

A

She should avoid sex or use effective contraception until menstrual period following operation

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9
Q

When is a man considered sterile after the operation?

A

Should not be considered sterile until semen samples with no spermatozoa have been confirmed

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10
Q

When should the man receive a semen sample with no spermatozoa?

A

Usually 12-16 weeks after the operation

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11
Q

What may be required when confirming a man is sterile after vasectomy?

A

1 or 2 tests

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12
Q

What should couples be advised of regarding choice of sterilisation procedure?

A

Vasectomy carries fewer risks as a procedure, and has a lower failure rate in terms of unwanted pregnancies

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13
Q

What alternative options are there to sterilisation?

A

Long-acting reversible methods of contraception

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14
Q

Give a limitation of sterilisation

A

Does not protect against STIs

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15
Q

What should ideally happen with counselling for sterilisation?

A

The couple should be seen and counselled together

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16
Q

What does the patient and their partner need to understand before proceeding with sterilisation?

A

Need to understand that sterilisation is irreversible

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17
Q

What theoretical situation can be used to ensure the couple are sure about sterilisation?

A

Even if tragedy were to befall their family, neither would wish to have more children

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18
Q

What things should be considered to reduce regret caused by sterilisation?

A
  • Age
  • Family structure
  • Relationship stability
  • Timing
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19
Q

What age groups are more likely to regret sterilisation?

A

Young people, especially under 30

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20
Q

What family structures are more likely to experience regret?

A

Couples with fewer than 2 children

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21
Q

What is there a risk of when a relationship breaks down with sterilisation?

A

Risk the sterilised partner will wish to have children with a new partner in a new relationship

22
Q

What should be considered regarding timing of sterilisation?

A
  • Tubal occlusion should be performed after an appropriate interval following pregnancy
  • Tubal ligation can be performed at C-section
  • Vasectomy in the partners pregnancy should be approached with care
23
Q

Why should vasectomy during a partners pregnancy be approached with care?

A

Even if current pregnancy is unplanned, stillbirth and neonatal death can still occur, so better to wait until healthy child is delivered and is several weeks old

24
Q

What should be done if tubal ligation is performed at C-section?

A

The obstetrician should ascertain that the paediatrician is happy the baby is healthy before proceeding

25
Q

What is the limitation of checking that the baby is healthy before proceeding with tubal ligation at C-section?

A

Problems may not be apparent immediately

26
Q

When should consent and counselling take place if tubal ligation is to be done at C-section?

A

At least 2 weeks before the procedure

27
Q

What is the aim of vasectomy?

A

Interruption of vas deferens

28
Q

What anaesthetic is used for vasectomy?

A

Local

29
Q

Describe the procedure for vasectomy

A

The vas deferens is exposed and isolated, and then the lumen is occluded and the vas deferens divided

30
Q

How is the success of vasectomy confirmed?

A

Post-operative semen analysis to confirm azoospermia

31
Q

When is the post-vasectomy semen analysis performed?

A

12 weeks post vasectomy

32
Q

What are the complications of vasectomy?

A
  • Bleeding into scrotum and haematoma formation
  • Infection
  • Epididymitis
  • Sperm granuloma
  • Persistent pain
  • Contraceptive failure
33
Q

How does a sperm granuloma present?

A

Tender scrotal swelling near proximal end of vas

34
Q

How is a sperm granuloma managed?

A

Requires further excision

35
Q

Where might persistent pain caused by vasectomy occur?

A
  • Testicles
  • Scrotum
  • Penis
  • Lower abdomen
36
Q

What % of men experience persistent pain after vasectomy?

A

1-14%

37
Q

Is persistent pain following vasectomy severe?

A

Can be in some men

38
Q

What is the rate of contraceptive failure of vasectomy after negative sperm count?

A

1 in 2000

39
Q

What approaches can be taken to female sterilisation?

A
  • Hysteroscopic
  • Laparoscopic
  • Open procedure
40
Q

What is done in hysteroscopic sterilisation?

A

Micro-inserts are implanted into the Fallopian tubes

41
Q

What is the result of inserting micro-inserts into the Fallopian tubes in hysteroscopic sterilisation?

A

Causes scar tissue to form, eventually blocking the ruebs

42
Q

Do you need to use contraception after hysteroscopic sterilisation?

A

Yes

43
Q

How long do you need to continue to use sterilisation after hysteroscopic sterilisation?

A

Until imaging (x-ray or ultrasound) has confirmed that the micro-inserts are correctly positioned

44
Q

What may be required to confirm tubal occlusion after hysteroscopic sterilisation in some patients?

A

Hysterosalpingogram

45
Q

When should imaging to confirm tubal occlusion be performed in hysteroscopic sterilisation?

A

3 months after the procedure

46
Q

Why is hysteroscopic sterilisation a good option?

A

The procedure has been shown to be safe, with low rates of adverse effects and high rates of patient acceptability

47
Q

What does laparoscopic sterilisation use?

A

Clips

48
Q

What should be done prior to laparoscopic sterilisation?

A

Pregnancy test

49
Q

What is the risk with laparoscopic sterilisation?

A

Risk of damage to the bowel or blood vessels

50
Q

What factors increases the risk of damage to bladder or bowel during laparoscopic sterilisation?

A
  • Obesity
  • Inexperienced operator
  • Abdominal adhesions
51
Q

What is the lifetime failure rate of female sterilisation?

A

1 in 200

52
Q

What risk is there with female sterilisation?

A

If pregnancy does occur, there is an increased risk of ectopic pregnancy